RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2015-01369
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “bilateral tibial plateau stress fractures with mild sclerosis” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20020111	VARD - 20020809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Plateau Stress Fractures with Mild Sclerosis	5099-5022	0%	Bilateral Tibial Plateau Stress Fractures with Mild Sclerosis	5262	NSC	20020726	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Tibial Plateau Stress Fractures with Mild Sclerosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg conditions began in October 2001 during basic training.  Bone scan was consistent with bilateral tibial plateau stress fractures and X-rays showed sclerosis about the medial plateau bilaterally.  Orthopedic evaluation recommended MEB due to early onset of stress fractures and leg pain symptoms prior to training.  The MEB forwarded “bilateral medial tibial plateau stress fractures” for PEB adjudication.  The MEB NARSUM examination on 13 December 2001, 2 months prior to separation, noted complaints of bilateral leg and knee pain up to 10/10 (severe).  Current pain at the examination was 4/10.  Physical examination showed each knee had a normal range of motion (ROM) of 0 to 140 degrees without any effusions, laxity or ligamentous instability.  Each knee was tender about the medial aspect of the knee.  The physician indicated that the bilateral medial tibial plateau stress fractures were moderately to severely symptomatic.  He indicated that “these fractures should heal without incident.  However, they will not heal if (the CI) continues military training.”  

At the 26 July 2002 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported bilateral knee pain due to tibial stress fractures.  Physical examination showed normal posture and gait.  The ROMs of both knees and ankles was to normal VASRD limits with no additional limitations by pain, fatigue, weakness, lack of endurance or incoordination.  X-rays of the left and right tibia and fibula were normal with no evidence of stress fracture.  The examiner stated that there was no pathology to render a diagnosis for the left or right claimed tibial plateau stress fracture condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the left tibial plateau stress fracture and the right tibial plateau stress fracture conditions as a single unfitting condition coded 5099-5022 (periostitis), and rated 0% citing no loss of range of motion.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The VA did not service-connect the bilateral tibial plateau stress fractures with mild sclerosis condition coded 5262 (tibia and fibula, impairment of), based on the VA C&P examination 6 months after separation, citing a normal VA examination with no finding of pathology and no diagnosis.  

The profile indicated bilateral tibial stress fractures with limitations, the NARSUM indicated continued Service would impede healing, and the MEB adjudged the bilateral tibial plateau stress fractures as not meeting retention standards.  There was no commander’s statement in evidence.  Treatment notes addressed bilateral knees/tibias without significant differences between the left and right side.  The panel concluded that there was not a preponderance of evidence of the service records that overcame the panel’s presumption that either of the bundled left and right tibial stress fracture condition was reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting left and unfitting right tibial stress fracture conditions at the time of separation.  As noted above, there were no distinctions with regards to clinical features or fitness considerations between the right and left tibial plateau stress fracture conditions.  The NARSUM examination was closest to separation and the more remote VA examination was adjudged to represent post-separation improvement.  

The panel deliberated if there was sufficient evidence of slight knee or ankle disability at separation to warrant a 10% rating for each side given that there was no limitation of knee or ankle ROM and no painful motion; or if the tibial plateau stress fractures with sclerosis were more closely analogous to degenerative arthritis (5003) for supporting a single 5003 based rating for “2 or more major joints” without significant ROM limitations or painful motion within the VASRD §4.71a latitude for a bilateral rating.  

Members agreed, that the evidence did not support recommending separate right and left disability ratings, but did support a bilateral 10% rating under 5003.  There was no evidence of incapacitating exacerbations for the higher 20% rating under 5003.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral tibial plateau stress fractures with mild sclerosis condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the bilateral tibial plateau stress fractures with mild sclerosis condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Tibial Plateau Stress Fractures with Mild Sclerosis	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006462, XXXXXXXXXXXXXXXXXX.

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely